Wide Confidence Intervals Research Articles

Upadacitinib and Cardiovascular Adverse Events in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Upadacitinib, a Janus kinase (JAK) inhibitor used in rheumatoid arthritis treatment, has prompted safety concerns due to potential cardiovascular adverse events. However, current evidence does not provide a definitive conclusion. We conducted a comprehensive systematic review of the literature up until March 15, 2024, utilizing databases like PubMed/Medline, Embase, and Cochrane CENTRAL. A meta-analysis approach was used to derive pooled odds ratios (OR) along with their 95% confidence intervals (CI) to assess the cardiovascular risk associated with upadacitinib. Publication bias was evaluated using Begg's and Egger's tests. Our meta-analysis included six studies with a total of 4,202 participants. For the 15 mg dosage of Upadacitinib, the pooled OR was 1.20 (95% CI: 0.3-4.3), indicating a nominal, non-significant increase in the risk of cardiovascular adverse events. Analysis of the 30 mg dosage presented a pooled OR of 2.37 (95% CI: 0.6-9.1), pointing to a higher, yet statistically insignificant, potential risk. The absence of publication bias was confirmed through Begg's and Egger's tests. The analysis suggests a potential heightened cardiovascular risk associated with Upadacitinib, more so with the 30 mg dosage. Nevertheless, the lack of statistical significance and the wide confidence intervals necessitate a prudent approach to these findings. Tailored treatment strategies, rigorous monitoring, and further empirical studies are crucial for refining the safety profile of upadacitinib and ensuring optimal patient outcomes.

Real-world effectiveness of nirmatrelvir-ritonavir and molnupiravir in non-hospitalised adults with Covid-19: a population-based, retrospective cohort study cohort study

ObjectivesThe real-world effectiveness of the oral antivirals nirmatrelvir-ritonavir and molnupiravir against the SARS-CoV-2 Omicron variant remains uncertain. We aimed to estimate their effectiveness in non-hospitalised adults with Covid-19. MethodsThis retrospective cohort study used data from the Municipal Department for Public Health Services of Vienna, Austria, to identify non-hospitalised adults with confirmed SARS-CoV-2 infection between Jan-2022–May-2023. Nirmatrelvir-ritonavir users were compared with untreated controls and molnupiravir users with untreated controls by calculating adjusted risk differences (aRDs) using a covariate-adjusted logistic regression model with inverse probability weighting. Outcomes were hospitalisation and all-cause death within 28 days. ResultsWe identified 113,399 eligible cases (90,481 untreated controls, 12,166 nirmatrelvir-ritonavir users, and 10,752 molnupiravir users). Over 96% of the patients were immunised by previous infection or vaccination. In the nirmatrelvir-ritonavir analysis, the estimated risk of hospitalisation was 0.57% (95%CI, 0.35–0.78) in nirmatrelvir-ritonavir users and 1.09% (95%CI, 0.86–1.32) in untreated controls (aRD -0.53%; 95%CI, -0.77–-0.28). The estimated risk of death was 0.0% (95%CI, 0.0–0.0) in nirmatrelvir-ritonavir users and 0.13% (95%CI, 0.08–0.18) in untreated controls (aRD -0.13%, 95%CI, -0.18–-0.08). The number needed to treat to prevent hospitalisation and death was 190 (95%CI, 130–356) and 792 (95%CI, 571–1289), respectively. These statistically significant aRDs were restricted to the subgroup of patients ≥60 years. In the molnupiravir analysis, the estimated risk of hospitalisation was 1.36% (95%CI, 0.95–1.77) in molnupiravir users and 1.16% (95%CI, 0.93–1.39) in untreated controls (aRD 0.2%; 95%CI, -0.08–0.49). The estimated risk of death was 0.12% (95%CI, 0.01–0.23) in molnupiravir users and 0.14% (95%CI, 0.06–0.21) in untreated controls (aRD, -0.01%; 95%CI, -0.08–-0.06). ConclusionsAmong outpatients aged ≥60 years with Covid-19 in an Omicron-dominated era, treatment with nirmatrelvir-ritonavir was associated with a lower risk of hospitalisation and all-cause death within 28 days, albeit with wide confidence intervals and high numbers needed to treat. This finding was not observed in molnupiravir users and younger nirmatrelvir-ritonavir users.

The Banksia plot: a method for visually comparing point estimates and confidence intervals across datasets

ObjectiveIn research evaluating statistical analysis methods, a common aim is to compare point estimates and confidence intervals (CIs) calculated from different analyses. This can be challenging when the outcomes (and their scale ranges) differ across datasets. We therefore developed a graphical method, the 'Banksia plot', to facilitate pairwise comparisons of different statistical analysis methods by plotting and comparing point estimates and confidence intervals from each analysis method both within and across datasets. Study design and settingThe plot is constructed in three stages. Stage 1: To compare results of two statistical analysis methods, for each dataset, the point estimate from the reference analysis method is centred on zero, and its confidence limits are scaled to range from -0.5 to 0.5. The same centring and scale adjustment values are then applied to the corresponding comparator analysis point estimate and confidence limits. Stage 2: A Banksia plot is constructed by plotting the centred and scaled point estimates from the comparator method for each dataset on a rectangle centred at zero, ranging from -0.5 to 0.5, which represents the reference method results. Stage 3: Optionally, a matrix of Banksia plots is graphed, showing all pairwise comparisons from multiple analysis methods. We illustrate the Banksia plot using two examples. ResultsIllustration of the Banksia plot demonstrates how the plot makes immediately apparent whether there are differences in point estimates and confidence intervals when using different analysis methods (example 1), or different data extractors (example 2). Furthermore, we demonstrate how different bases for ordering the confidence intervals can be used to highlight particular differences (i.e. in point estimates, or confidence interval widths). ConclusionThe Banksia plot provides a visual summary of pairwise comparisons of different analysis methods, allowing patterns and trends in the point estimates and confidence intervals to be easily identified.

A comparative study of the performance of new ridge estimators for multicollinearity: Insights from simulation and real data application

This paper addresses the challenge of multicollinearity in regression models, a condition that inflates the standard errors of coefficients, leading to unreliable estimates and wider confidence intervals. Multicollinearity, characterized by high intercorrelations among independent variables, undermines model accuracy by increasing the variance of the estimated coefficients, making them more sensitive to changes in the data and difficult to interpret. In this paper, we introduce three novel ridge estimators specifically designed to analyze data affected by multicollinearity. These are the Balanced Log Ridge Estimator (BLRE), the Inverse Influence Ridge Estimator (IIRE), and the Adaptive Shrinkage Ridge Estimator (ASRE), all designed to enhance estimation accuracy and stability in the presence of high multicollinearity and noise. Through Monte Carlo simulations and empirical analysis on a highly correlated real dataset, ASRE consistently demonstrates superior performance, achieving the lowest mean squared error compared to existing ridge estimators. The IIRE and BLRE also perform well; however, ASRE proves to be the most robust, especially in extreme scenarios. In contrast, the ordinary least squares estimator performs poorly under these conditions, underscoring the effectiveness of the new estimators. ASRE is recommended for most situations, with IIRE as a reliable alternative, offering significant improvements in handling multicollinearity.

A selective diesel vehicle ban’s impact on NO2 concentrations in Munich: a quasi-experimental study

Abstract Background The European Union’s current NO2 concentration limit of 40 μg/m³ is regularly exceeded in Munich, Germany. This limit is likely to be reduced towards the WHO recommended target of 10 μg/m³. In response, the city enacted a selective ban on older diesel vehicles, specifically those categorized as Euro 4 or older, within the current low-emission zone in February 2023. Our study examined how Munich’s selective ban on diesel vehicles impacted NO2 levels, concentrating on the six-month period after its introduction. Methods We employed a synthetic control approach in the primary analysis and a controlled interrupted time series approach in the secondary analysis. These quasi-experimental methods establish a ‘counterfactual’ no-intervention scenario, allowing for comparison with the actual observed scenario and estimation of the impact of the intervention. Historical data from monitoring stations within and outside the low-emission zone from 2014 to 2022 were utilized as controls, while potential confounders were considered. Results NO2 concentrations within Munich’s low-emission zone decreased across the study period. Effects of the selective diesel vehicle ban at monitoring stations within the low-emission zone were minimal, with wide confidence intervals indicating uncertainty. At Landshuter Allee, the average intervention effect was -2.67 μg/m3 (95%-CI = [-12.72; 7.38]), at Stachus it was -2.74 μg/m3 (95%-CI = [-9.91; 4.42]) and at Lothstrasse, it was -1.03 μg/m3 (95%-CI = [-7.75; 5.69]). The secondary analysis confirms these findings. Conclusions Munich’s selective diesel vehicle ban had limited effects in reducing NO2 concentrations. Factors such as its narrow focus on Euro 4 diesel vehicles, numerous exemptions, and unclear enforcement may explain this outcome. Comprehensive strategies and continuous monitoring and evaluation are crucial for effectively addressing urban air pollution and protecting public health. Key messages • Munich’s selective diesel vehicle ban had minimal effects on reducing NO2 levels, possibly due to its narrow scope, many exemptions, and unclear enforcement. • Current guidelines and court rulings signal the need for more effective solutions beyond selective bans, emphasizing the importance of well-designed interventions and rigorous evaluation.

Burden of disease due to road traffic noise in Flanders, Belgium

Abstract This study estimates the disease burden of ischemic heart disease (IHD), stroke and diabetes mellitus attributable to road traffic noise in the Flemish Region (Belgium) for the year 2020, expressed in disability-adjusted life years (DALYs). The research proposes an approach to stratify population exposure to noise according to age and sex, which allows to examine internal differences in noise burden related to both varying risk and baseline burden. Stratification of population exposure to noise is achieved by (1) linking modelled noise exposure to age- and sex-stratified population data at small area-level, (2) dividing the prevalence in each exposure class proportionally over the strata, and (3) aggregating the small areas to a Flemish total per stratum. Annual day-evening-night level exposure is translated into the fraction of attributable burden relying on relative risks (RR) from the WHO’s Environmental Noise Guidelines and more recent studies. Baseline burden for the three outcomes is sourced from the Belgian National Burden of Disease Study. The lower and upper bound of the RR’s 95% confidence interval (CI) are used to calculate the uncertainty range on the burden estimates. The total noise DALYs estimated are 1092 (95% CI: 135, 2061) for IHD, 761 (379, 1017) for stroke, and 671 (486, 918) for diabetes. Noise burden rates rise steeply with age for all outcomes, although the wide CIs on the IHD estimates prevent to ascertain a significant trend. The IHD burden is twice as high in men as in women, while both sexes are almost equal for the other outcomes. The variations between age and sex groups are largely explained by differences in baseline burden, as exposure is fairly constant across strata. This study estimates age- and sex-stratified disease burden attributable to noise traffic in Flanders, Belgium. As differential exposure between the population subgroups is limited, any variation in noise DALYs is mainly related to stratum-specific baseline burden. Key messages • Road traffic noise is responsible for hundreds of healthy life years lost in Flanders, Belgium. • The noise burden for stroke and diabetes rises sharply with age, and the burden for ischemic heart disease is twice as high in men as in women.

Sex differences in mortality associated with heatwaves: a systematic review and meta-analysis

Abstract Introduction The existence of sex and gender differences in the mortality associated with heatwaves remains unclear. Methods A systematic review and random-effects meta-analysis of population-based studies that investigated the mortality associated with heatwaves and reported results stratified by sex/gender was conducted (PROSPERO registration CRD42023430208). Bibliographic databases Medline and Embase were searched from inception to May 2024 with MESH terms for heatwaves/extreme heat and mortality. This was complemented with hand-searching of reference lists of relevant studies. The methodological quality of eligible studies was assessed using the Joanna Briggs Institute critical appraisal tool. Results In total, 931 studies were identified, of which 32 studies were included in the qualitative review and 11 in the meta-analysis. Most studies (20/32) reported a higher risk of heat-related death for women than men even after adjusting for or stratifying by age. Twelve studies showed statistically significant higher risks of death for women than men and 7 studies identified an increased risk of death for women, but the wide confidence intervals precluded making definite conclusions. Two studies reported a higher risk of death for men in comparison to women but only one was statistically significant. The remaining 10 studies found comparable risks for women and men. For the 11 studies included in the meta-analysis, women had an 8% increased risk of death in comparison to men (RR 1.08, 95% CI [1.02 to 1.14]). There was significant heterogeneity (I2=69%, p = 0.001) due to the variability in the definition of exposure, population, and setting. Most studies had a low to moderate risk of bias. Conclusions Women appeared to have an increased risk of death associated with heatwaves in comparison to men. Further research is warranted to understand the underlying factors and ensure the health protection response considers the gendered impact of heatwaves.

The application of Bayesian method in estimating heterogeneity of treatment effect

It is well recognized that the benefit of medical interventions may not be distributed evenly in the target population due to patient heterogeneity, and conclusions based on traditional randomized clinical trials do not apply to everyone. Considering the increasing cost of randomized trials and difficulties in recruiting patients, there is an urgent need to develop analytical methods to estimate treatment effects in subgroups. In particular, due to limited sample sizes of subgroups, standard analysis tends to yield wide confidence intervals for the treatment effect, which are often uninformative. In this article, the superiority of the empirical Bayes estimate of the conditional average treatment effect is demonstrated by using a linear regression model to specifically represent treatment-covariate interactions. To obtain more accurate prior distributions and posterior estimates of treatment effects in subgroups, we utilize the covariate-dependent precision parameter across subgroups. Based on subgroup data obtained from clinical trials, the covariate-dependent precision parameter is used to assess the similarity of treatment effects across subgroups, which is an approach to obtain more reasonable prior information. To verify the validity of the empirical Bayes method, we evaluate it by a real clinical trial comparing insulin and metformin.

Psychiatric Comorbidities in Women with Complete Androgen Insensitivity Syndrome or Müllerian Aplasia/Agenesis.

Understanding mental health issues facing individuals with disorders/differences of sex development (DSD) is crucial for optimizing evidence-based practices in this population. To compare the prevalence of psychiatric diagnoses among patients diagnosed with complete androgen insensitivity syndrome (CAIS) or Müllerian duct aplasia/agenesis (MA) to male and female reference groups. Retrospective cohort study. Three large integrated health systems. All individuals with confirmed CAIS or MA enrolled in one of three Kaiser Permanente healthcare systems between January 1, 1988, and January 31, 2017. For each DSD patient, age-, race/ethnicity- and health system-matched male and female referents with typical sex development were randomly selected. Mental health diagnoses and use of psychiatric medications. The prevalence of anxiety and depressive disorders in the CAIS and MA cohorts was approximately twice as high as in male referents without DSD, but the corresponding differences relative to female referents were less evident. A subgroup of MA patients with uterine agenesis had higher prevalence of bipolar disorder than either reference group, but these results were accompanied by wide confidence intervals. Women with CAIS and MA more frequently filled psychiatric medications compared to male but not female referents. On balance, these findings are reassuring, albeit requiring confirmation in other settings. Future studies using longitudinal designs and patient-reported outcomes are needed to evaluate changes in mental health status of CAIS and MA patients at different ages and different intervals following initial diagnosis.

Munich’s selective diesel vehicle ban and its impact on nitrogen dioxide concentrations: A quasi-experimental study

BackgroundThe current limit on NO2 concentrations of 40 μg/m3, set by the European Union, has been regularly exceeded in Munich, Germany. This limit will likely be reduced towards the WHO recommended target of 10 μg/m3. Against this backdrop, the city implemented a selective diesel vehicle ban within the existing low-emission zone in February 2023, targeting Euro 4 and older diesel vehicles. Our study investigated the effect of Munich’s selective diesel vehicle ban on NO2 concentrations, focusing on the half-year period following its implementation. MethodsOur study utilized a synthetic control approach (primary analysis) and a controlled interrupted time series approach (secondary analysis). These quasi-experimental methodologies create a ‘counterfactual’ no-intervention scenario, enabling comparison between observed and counterfactual scenarios to estimate an intervention effect. We employed historical controls, using routine data from multiple monitoring stations located within and outside the low-emission zone for 2014 to 2022, and considered possible confounders. ResultsNO2 concentrations within Munich’s low-emission zone showed overall declining trends from August 2014 to July 2023. Effects of the selective diesel vehicle ban were small and wide confidence intervals indicate large uncertainty in the magnitude and direction of the effect. At Landshuter Allee, the average intervention effect was −2.67 μg/m3 (95 %-CI = [-12.72; 7.38]), at Stachus it was −2.74 μg/m3 (95 %-CI = [-9.91; 4.42]), and at Lothstrasse it was −1.03 μg/m3 (95 %-CI = [-7.75; 5.69]). The secondary analysis confirmed these findings, reinforcing uncertainty about the effect of the intervention. ConclusionOur study suggests that Munich’s selective diesel vehicle ban had a limited effect on lowering NO2 concentrations. Possible explanations include the ban’s focus on Euro 4 and older diesel vehicles, many exemptions to the selective ban, and unclear enforcement. This highlights that comprehensive approaches and ongoing, well-designed monitoring and evaluation are crucial for addressing urban air pollution and protecting public health.

Adverse Events as a Cause of Unblinding of Allocated Arms in Anti-Amyloid Therapy Trials: A Meta-Analysis of the Predictive Value.

Anti-amyloid drugs for early Alzheimer's disease, including lecanemab, are associated with adverse events (AEs), such as amyloid-related imaging abnormalities (ARIA)-edema/effusion (E), ARIA-hemorrhage, and infusion-related reactions, which can indicate allocated arms in clinical trials. Herein, we evaluated the predictive value of AEs using a meta-analysis to estimate their incidence and simulated positive predictive value (PPV). The PPV for ARIA-E was high (0.915), but that for ARIA hemorrhage was low (0.630). Infusion-related reactions had a high PPV of 0.910, but with a wide confidence interval. Our results suggest the need to ameliorate the unblinding effects of AEs, particularly ARIA-E in trials.

The Method for Obtaining Shot Cloud Time Span and Range Dependence

When studying the behavior of a shot cloud in space, a variety of information and measurement systems can be applied, for example, based on light screens (photoelectronic blocking devices of a small ballistic measuring installation consisting of a linear emitter and an optical sensor based on a photodiode). To study the process of shot cloud movement in space and to assess its parameters (for example, length at a given range from the muzzle) correctly, it is advisable to have a simulation model of the optical sensor signal when the light screen is crossed by a shot cloud. Taking into account previous studies, it is necessary to know the magnitude of the scale parameter in the Rayleigh distribution describing the shot cloud in the direction of firing in time in order to obtain a similar model at some distance from the muzzle. A method that allows obtaining function of dependence of the mentioned scale parameter and the distance from the muzzle and based on real data from several optical sensors of light screens installed on the shooting track is proposed. The example of application the proposed method to obtain similar functions based on the results of processing optical sensor signals obtained in real experiments for cartridges loaded with three different shot types is given. The obtained dependences were approximated by polynomials of the first and second degree using the least squares method, and the error was estimated for various types of cartridges. Based on the obtained results, specific recommendations for the practical application of the developed method are proposed. The estimation of the confidence interval width for the expectation function of the shot cloud time span is performed. The ways of creating advanced signal simulation models from optical sensors of light screens when shooting with shot are outlined.

Cancer mortality risk in the Urals Cohort of Exposed Population Offspring

The objective of the study is to analyze solid cancer mortality and estimate the risk value of solid cancer mortality in the offspring of parents irradiated in the Southern Urals, depending on the dose to the parents' gonads as well as to conduct a preliminary assessment of the mortality risk from cancer of individual locations depending on the gonadal dose. The issue of the transgenerational effects of the human gonad exposure is still very important. There exists conclusive evidence of the presence of such effects in experimental animals. However, there is no proof of the existence of these effects in humans despite a great number of research on this subject. International scientific community and international organizations, UNSCEAR and ICRP being among them, regard this issue as the one that has not been solved yet and requires further studies. Urals Cohort of offspring of the population exposed on the Techa River and on the territory of the East Ural radioactive trace was established in the Urals research Center for Radiation medicine in 2022. The key feature of the cohort is the exclusion of the offspring with postnatal exposure. The size of the cohort as of September 2023 is 31,154 persons. The number of person-years over the whole follow-up period from 1950 through 2020 is 1 226 380. Mean dose to the gonads of mothers of all the cohort members is 41 mGy, to those of the fathers' — 35 mGy, mean combined gonad dose is 76 mGy. Over the whole follow-up period 3,774 deaths from all causes including 284 deaths from solid cancers were registered in the cohort. The mean age of the cohort members at the end of the follow-up period was 42 years. The risk of death was analyzed using Poisson regression by the programs of the EPICURE statistical software package. Three models of dose dependence were tested: linear, quadratic, and linear-quadratic models of paternal gonadal dose, maternal gonadal dose, and total gonadal dose. Mortality risk analysis of all solid cancers in the offspring cohort showed no statistically significant effect with parental gonadal dose (we have obtained positive although statistically insignificant values of solid cancers mortality risk) which is consistent with the results of other studies in human populations. At the same time, the analysis for the first time obtained a statistically significant linear dependence of the solid cancer mortality risk in offspring with father's age over 45 years depending on the dose to the father's gonads. The excess relative risk of death was 8.09/Gy, (0.51-22.93), p < 0.05. Also, for the first time, evidence of dose dependence of the mortality risk of lung cancer in male offspring on maternal gonadal dose, paternal gonadal dose, and combined gonadal dose was obtained. The values of excess relative risk of lung cancer and 95% confidence intervals according to the linear model were 5.39/Gy (0.46; 15.56) from paternal gonad dose, 4.36/Gy (0.15; 13.48) from maternal gonad dose, and - 3.95/Gy (0.55; 12.14) from combined gonad dose. Point risk estimates of lung cancer at this stage are characterized by wide confidence intervals and require additional studies to assess the influence of possible effect modifiers, but with a high degree of probability indicate the presence of dose dependence of this effect. Increasing the follow-up period and attained age, will increase the number of cancers in the future and will reduce dose response uncertainties and provide more accurate estimates of the risk of death in the offspring cohort.

When the attention control condition works: A systematic review of attention control training for posttraumatic stress disorder.

Attentional bias and deficits in attentional control are associated with posttraumatic stress disorder (PTSD) symptoms. Attention control training (ACT) may address these factors. We reviewed randomized controlled trials (RCTs) of ACT for PTSD to address unanswered questions about ACT's effectiveness, tolerability, and implementation. Studies were included if they were an RCT that used an adult sample, recruited participants with a PTSD diagnosis, and had ACT as at least one treatment arm. The PTSD Trials Standardized Data Repository (PTSD-Repository) and additional databases were searched to identify PTSD RCTs published through May 2024. Seven studies met the inclusion criteria (N = 407). The effect size for ACT versus a comparison condition on PTSD symptoms was large, but the confidence interval (CI) overlapped with 0, g = 0.75, 95% CI [-0.63, 2.12]. The same pattern was observed for attention bias variability, g = 1.04, 95% CI [-0.90, 2.98]. There was a significant within-group effect of ACT on self-reported PTSD symptoms, g = -1.43, 95% CI [-2.83, -0.03]. Risk of bias varied, with high risk of bias being primarily due to bias in the measurement of the outcome. These effects should be interpreted cautiously given the significant heterogeneity and wide confidence intervals observed. It remains unclear for whom and under what conditions ACT may be most effective. Future studies should move beyond response time measures, employ an inactive comparator, and examine the mechanism of action to determine whether ACT could be a viable intervention for PTSD.

Outcomes with revascularisation versus conservative management of participants with 3-vessel coronary artery disease in the ISCHEMIA trial.

Whether revascularisation (REV) improves outcomes in patients with three-vessel coronary artery disease (3V-CAD) is uncertain. Our objective was to evaluate outcomes with REV (percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) versus medical therapy in patients with 3V-CAD. ISCHEMIA participants with 3V-CAD on coronary computed tomography angiography without prior CABG were included. Outcomes following initial invasive management (INV) with REV (PCI or CABG) versus initial conservative management (CON) with medical therapy alone were evaluated. Regression modelling was used to estimate the outcomes if all participants were to undergo prompt REV versus those assigned to CON. Outcomes were cardiovascular (CV) death/myocardial infarction (MI), death, CV death, and quality of life. Bayesian posterior probability for benefit (Pr [benefit]) for 1 percentage point lower 4-year rates with REV versus CON were evaluated. Among 1,236 participants with 3V-CAD (612 INV/624 CON), REV was associated with lower 4-year CV death/MI (adjusted 4-year difference: -4.4, 95% credible interval [CrI] -8.7 to -0.3 percentage points, Pr [benefit]=94.8%) when compared with CON, with similar results for PCI versus CON (-5.8, 95% CrI: -10.8 to -0.5 percentage points, Pr [benefit]=96.4%) and CABG versus CON (-3.7, 95% CrI: -8.8 to 1.5 percentage points, Pr [benefit]=84.7%). Adjusted 4-year REV versus CON differences were as follows: death -1.2 (95% CrI: -4.7 to 2.2) percentage points, CV death -2.3 (95% CrI: -5.5 to 0.8) percentage points, with similar results for PCI and for CABG. The Pr (benefit) for death with REV (PCI or CABG) versus CON was 49-63%. The adjusted 12-month Seattle Angina Questionnaire-7 summary score differences favoured REV: REV versus CON 4.6 (95% CrI: 2.7-6.4) percentage points; PCI versus CON 3.6 (95% CrI: 1.2-5.8) percentage points and CABG versus CON 4.3 (95% CrI: 1.5-6.9) percentage points with high Pr (benefit). In participants with 3V-CAD, REV (either PCI or CABG) was associated with a lower 4-year CV death/MI rate and improved quality of life, with similar results for PCI versus CON and CABG versus CON. The differences in all-cause mortality between REV and CON were small with wide confidence intervals. (ClinicalTrials.gov: NCT01471522).

Effect of Music Therapy on Quality of Life in Geriatric Population: A Systematic Review and Meta-Analysis

The older population is susceptible to dementia, Alzheimer’s and depression. A growing elderly population poses a burden on caregivers and society. If their cognitive and psychological health is maintained, they may not need to depend on others for their needs, thereby reducing the burden on caregivers. This, in turn, may lead to a decrease in the necessity for consulting healthcare providers for psychological health, subsequently reducing the overall cost of healthcare. There are numerous options for improving cognitive and mental health in the elderly, one of which is music therapy (MT). In this systematic review, we aim to demonstrate the efficacy of MT in enhancing psychological health among the geriatric population afflicted with dementia and depression. A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed, Scopus, ScienceDirect, and Cochrane databases. The inclusion criteria were randomized controlled trials (RCTs) that explored the use of MT in elderly patients with or without depression, dementia, or Alzheimer’s. Non-RCTs, retrospective and prospective observational studies, case reports, and case series were excluded. Out of 76 records identified, eight articles were selected for qualitative synthesis and three for meta-analysis. These studies, conducted between 2010 and 2020, involved a total of 605 subjects, with 330 receiving MT and the remainder serving as controls. The interventions varied in terms of music type, duration, and setting, with outcome measures including depression scales, quality of life assessments, and cognitive examinations. The meta-analysis of depression scores indicated a positive effect of MT, though a wide confidence interval warrants caution. The quality assessment revealed varying risks of bias, highlighting the need for further research to confirm the positive role of MT. In conclusion, MT emerges as a promising intervention, but it is accompanied by considerable limitations and heterogeneity among studies. This emphasizes the need for further RCTs that specifically address the identified limitations, including issues related to sample size, control group selection, and potential confounding factors. Conducting more robust research in these areas is crucial to establishing a clearer understanding of the therapeutic benefits of music in the elderly population.

Is the population of kingfish (Scomberomorus commerson) in the northern Persian Gulf really under pressure from overfishing?

AbstractQuantifying the population dynamics of marine species is difficult when good, comprehensive data are not available. We sought to determine if the kingfish Scomberomorus commerson stock in the Persian Gulf was overfished. The ICES data‐limited assessment framework was used to provide precautionary advice, with a 20% decrease advised in situations where only catch or bycatch data were available. The length‐based Bayesian biomass (LBB) was used to model fork length from landing records of licensed fishers in the Khuzestan Province during 2002–2018, which had increased despite sought being overexploited. Most kingfish were immature and smaller than optimum length of the catch (Lc‐opt = 88 cm) and optimum length (Lopt = 104 cm). Relative biomass (B/Bmsy) ranged 0.62–0.66 and exceeded 0.5. The B/Bmsy ratio (1.25) was >1.1. The stock appeared to be healthy and exploitable, but wide confidence intervals of the B/Bmsy ratio complicated interpretation of stock status. The kingfish stock appeared to use waters of the study area as a spawning and nursery ground, so many young immature individuals were present. If current exploitation of young individuals continues, this the stock will eventually be overfished. Long‐term increases in the catch of young immature kingfish can have a side effect on stock maturation and recruitment. We recommend that the mesh size of fishing gear be selected based on optimum length, to enhance economic, and commercial viability of the kingfish fishery.

Racism and health and wellbeing among children and youth–An updated systematic review and meta-analysis

BackgroundEvidence of racism's health harms among children and youth is rapidly increasing, though attention to impacts on physical health and biomarker outcomes is more emergent. We performed a systematic review of recent publications to examine the association between racism and health among children and youth, with a meta-analysis of the specific relationships between racism and physical health and biomarkers. MethodsWe conducted a systematic literature search using four databases: Medline, PsycINFO, PubMed, and ERIC. Four inclusion criteria were used to identify eligible studies: (1) exposure was experiences of racism, (2) outcome was health and wellbeing, (3) quantitative methods were used to estimate the association between racism and health outcomes, and (4) the effect size of associations between racism and health and wellbeing was reported for participants aged 0–24 years. Correlation coefficients were used to report the pooled effect size for each outcome indicator. ResultsThere were 463 eligible studies included in the screening process, with 42 studies focusing on physical health or biomarker outcomes. Random-effects meta-analysis found minimal to moderate positive associations between racism and C-reactive protein, Interleukin 6, body mass index (BMI), obesity, systolic blood pressure, salivary cortisol, asthma, and somatic symptoms. There were marginal positive associations between racism and Tumour Necrosis Factor-α, cortisol collected via saliva, urine and hair, BMI-z score, and diastolic blood pressure, with imprecise estimates and wide confidence intervals. ConclusionsRacism is associated with negative physical health and biomarker outcomes that relate to multiple physiological systems and biological processes in childhood and adolescence. This has implications for health and wellbeing during childhood and adolescence and future chronic disease risk. Collective and structural changes to eliminate racism and create a healthy and equitable future for all children and youth are urgently required.

Obstetric Perineal Tears, Birth Characteristics and the Association with Urinary Incontinence Among Primiparous Women 12 Months Postpartum: A Prospective Cohort Study.

Postpartumurinary incontinence (UI)is common and aconcern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women. A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI. A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95% CI 0.92-4.50; episiotomy: RR 2.22, 95% CI 0.99-4.96; third- or fourth-degree tear: RR 2.73, 95% CI 1.18-6.28). The same was found for SUI, but with wider confidence intervals. A higher prevalence of any UI and SUI was found among women with perineal tears involving any perineal muscles, compared with women with no, labia, or first-degree tears.

Asymptotic Confidence Interval, Sample Size Formulas and Comparison Test for the Agreement Intra-Class Correlation Coefficient in Inter-Rater Reliability Studies.

The agreement intra-class correlation coefficient (ICCa) is a suitable statistical index for inter-rater reliability studies. With balanced Gaussian data, we prove the explicit form of ICCa asymptotic normality (ASN), valid both with analysis of variance (ANOVA), maximum likelihood (ML), or restricted ML (REML) estimates. An asymptotic confidence interval is then derived and its performances are examined by simulation compared to the most commonly used methods, under small, moderate and large sample size designs. Then, we deduce sample size calculation formulas, for the number of subjects and observers needed, to achieve a desired confidence interval width or an acceptable ICCa value test power and give concrete examples of their use. Finally, we propose a likelihood ratio test (LRT) to compare two ICCa's from two distinct subpopulations of patients (or raters) and study by simulation its first order risk and power properties. These methods are illustrated using data from two inter-rater reliability studies, one in physiotherapy with 42 patients and 10 raters and the second in neonatology with 80 subjects and 14 raters. In conclusion, we made recommendations to employ the proposed confidence interval for medium to large samples combined with the quantification of the minimal required sample size at the planning step, or the posterior-power at the analysis step, using simple dedicated formulas. Furthermore, with sufficient sizes, the proposed LRT seems suitable to compare inter-rater reliability between two patient subpopulations. Used wisely, this proposed methods toolbox can remedy common current issues in inter-rater reliability studies.